Healthcare Provider Details

I. General information

NPI: 1235495797
Provider Name (Legal Business Name): DURE FERNANDEZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BROOK AVE
WICHITA FALLS TX
76301-5602
US

IV. Provider business mailing address

1208 BROOK AVE
WICHITA FALLS TX
76301-5602
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-4480
  • Fax: 940-322-8420
Mailing address:
  • Phone: 940-322-4480
  • Fax: 940-322-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DURE FERNANDEZ
Title or Position: OWNER/SOLE MEMBER
Credential: M.D.
Phone: 940-322-4480